Talk:Influenza/Archive 3

Deaths Caused by Influenza - update and correct statistics
From the article: "On average 41,400 people died each year in the United States between 1979 and 2001 from influenza.[8]" This should be corrected and updated to reflect the CDC statistics on causes of death (http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf, National Vital Statistics Reports, Vol. 58, No. 19, May 20, 2010, p. 34) which is stated as 411 deaths from influenza and 52,306 deaths from pneumonia in 2007. Lancecochrane386 (talk) 12:09, 21 October 2010 (UTC)LanceCochrane

rcpamanual site compromise has been fixed, says its admin.
... the rcpamanual site was affected for a couple of days in September by a x-scripting attack, but this was resolved a several weeks ago by upgrading the version of Joomla it was running on. The infection was noticed by the anti-virus system we use (Sophos) and by TrendMicro, but both took it off their suspect list within hours of being notified that it was fixed. I have look at the URL you sent, and they request that they be notified if a suspect site has been fixed, but I am unable to find a way of doing it, probably because I am not a subscriber.

Thanks for taking the time to notify us, but be assured the site is safe. If you could let the administrator of clean-mx.de know this, it would be appreciated.

Regards

PeterY

- Peter Youll ICT & Facilities Manager The Royal College of Pathologists of Australasia 207 Albion Street, Surry Hills, NSW 2010, Australia Tel direct +61 2 8356 5808 Mobile     +61 4 1280 3058 Tel switch +61 2 8356 5858 Fax          +61 2 8356 5828 Email petery@rcpa.edu.au —Preceding unsigned comment added by Ocdncntx (talk • contribs) 13:04, 8 November 2010 (UTC)

Antigenic drifts and actinomycin D and alpha-amantin
Antigenic DRIFTS are responsible for the sudden antigenic changes, not antigenic shifts. Antigenic shifts are the major changes that occur when a cell has been infected with two genetically distinct influenza viruses; the genomic RNAs of those two viruses in turn reassemble, resulting in a new strain of virus. This occurs, for example, when an individual has been infected with a human strain and a bird strain at the same time- generally when an individual has been infected with two types of the virus. Antigenic shifts are responsible for the worldwide epidemics of the flu that occur about every ten years, such as with the Influenza A virus.

Antigenic drifts occur when minor antigenic changes occur in the Hemagglutinin and Neuraminidase proteins; this is due to random mutations via amino acid substitutions. These are responsible for the yearly outbreaks of the flu virus such as with the influenza B virus.

In regards to the pathogenicity of the influenza viruses that inhibit host cell mRNA synthesis, this is due to the Actinomycin D and alpha-amantin that is encoded by the viral genome. The synthesis of these compounds occurs in the nucleus, and they in turn inhibit eukaryotic RNA pol II, thus inhibiting host cell mRNA transcription bob.

Source: Lange Review of Microbiology and Immunology, 10th Edition. Warren Levinson —Preceding unsigned comment added by 209.59.74.4 (talk) 11:25, 27 November 2010 (UTC)

209.59.74.4 (talk) 12:00, 27 November 2010 (UTC)


 * The source has been misunderstood: "Antigenic drift (is) he gradual accumulation of amino acid changes in the surface glycoproteins of influenza viruses. Antigenic shift (is) the sudden appearance of  antigenically novel surface glycoproteins in influenza A virus."  Source "Desk Encyclopedia of General Virology" p. 524 ISBN978-0-12-375146-1 Graham Colm (talk) 13:00, 27 November 2010 (UTC)
 * My understanding is that actinomycin is derived from soil bacteria and alpha-amantin from mushrooms and they are not encoded by the viral genome. Graham Colm (talk) 13:14, 27 November 2010 (UTC)

Patients with flu symptoms and chest X-ray showing possible pneumonia: New Eng J Med (Nov. 12, '09) recommends BOTH antivirals AND antibiotics.
Hospitalized Patients with 2009 H1N1 Influenza in the United States, April–June 2009, New England Journal of Medicine, Jain, Kamimoto, et al., Nov. 12, 2009:

“ .  .  .  the only variable that was significantly associated with a positive outcome was the receipt of antiviral drugs within 2 days after the onset of illness.”  (Outcomes, second paragraph)

" .  .  .  In our study, only 73% of patients with radiographic evidence of pneumonia received antiviral drugs, whereas 97% received antibiotics. In the absence of accurate diagnostic methods, patients who are hospitalized with suspected influenza and lung infiltrates on chest radiography should be considered for treatment with both antibiotics and antiviral drugs.  .  .  " (Discussion, 8th paragraph)

“ .  .  .  The benefits of treatment are probably greatest when such therapy is started early, but antiviral drugs should not be withheld if patients present more than 48 hours after the onset of symptoms. . .  ”  (Discussion, last paragraph)


 * posted by Cool Nerd (talk) 00:01, 7 January 2011 (UTC)

M2 inhibitors (adamantanes)
"These drugs are sometimes effective against influenza A if given early in the infection but are always ineffective against influenza B because B viruses do not possess M2 molecules." -influenza B viruses possess diferent M2 molecules, see: http://www.jbc.org/content/281/14/8997.full --147.142.120.221 (talk) 18:57, 18 April 2011 (UTC)

WHO, Nov. 2009, about H1N1: Pregnant women, kiddos under 2, people w/asthma-->antivirals right away. If trouble breathing-->antivirals. If pneumonia-->BOTH antivirals AND antibiotics.
Transcript of virtual press conference with Gregory Hartl, Spokesperson for H1N1, and Dr Nikki Shindo, Medical Officer, Global Influenza Programme, World Health Organization, 12 November 2009:

‘ .  .  .  In a country where the virus is circulating, we have 3 updated recommendations.

‘1. Firstly, people in at-risk groups need to be treated with antivirals as soon as possible when they have flu symptoms. This includes pregnant women, children under 2 years old, and people with “underlying conditions” such as respiratory problems.

‘2. Secondly, people who are not from the at-risk group but who have persistent or rapidly worsening symptoms should also be treated with antivirals. These symptoms include difficulty breathing and a high fever that lasts beyond 3 days.

‘3. Thirdly, people who have already developed pneumonia should be given both antivirals and antibiotics, as we have seen that, in many severe cases of H1N1-caused illness, bacterial infection develops. These medicines, antivirals and antibiotics, if used in a timely manner, can help save lives.

‘I want to stress that people who are not from the at-risk group and who have only typical cold need not take antivirals. . .  ’ (page 1)

+++

' .  .  .  The pandemic virus can cause severe pneumonia even in healthy young people, though rather minor in proportion, and the virus can take life within a week. The window of opportunity is very narrow to reverse the progression of the disease. The medicine needs to be administered before the virus destroys the lungs. . .  ' (page 2, second paragraph)


 * posted by Cool Nerd (talk) 17:42, 13 January 2011 (UTC)

Recent edits
I am concerned that recent edits are not to FA standards. This is a Featured Article and although all articles need updating, I would expect to see more discussion here before proposed changes are implemented. The prose and sources used have been previously, meticulously scrutinised, but now I see the introduction of advice, which Wikipedia does not offer, (this is policy), and sloppy writing. I have great respect for User:Cool Nerd contributions to the 2009 pandemic article, but I think the journalistic style that is being introduced to this FA is not appropriate for this Main Article. We have to keep 'flu in an historical perspective, and not be overwhelmed with current cases. Graham Colm (talk) 23:11, 14 January 2011 (UTC)


 * Graham, thank you for your kind words. And thank you for the good work you've done over time.  The line where I added "The standard advice is that if a person starts to have trouble breathing, he or she should seek medical attention promptly," I meant "The standard advice . . . " almost as a qualifier.  As in, here it is, take it for what it's worth, and what you do with it is up to you.  All the same, that line is clumsy and can be improved upon.  Cool Nerd (talk) 16:32, 19 March 2011 (UTC)

"occasionally causes pneumonia" in opening paragraphs?
I think so. I think we should say something to the effect: Influenza occasionally causes either acute respiratory distress syndrome or pnueumonia. And this pneunomia can be either direct viral pneumonia or secondary bacterial pneumonia. Senior citizens and children are at more risk, but any influenza patient has some chance of experiencing severe complications. Cool Nerd (talk) 20:41, 19 March 2011 (UTC)


 * Yes, I agree, but we need a reliable secondary source for this, preferably from PubMed. Graham Colm (talk) 16:28, 20 March 2011 (UTC)


 * I think we have a lot of middle area and can probably work together very well on the subject of pneumonia. And if you have the time, I'd appreciate a couple of pointers on how to better use PubMed.  I'm always interested in learning new things.  Now, down the road, we might potentially have some disagreement, as I generally take the view that I am open to a wide variety of sources (and frankly, I take the standards of wikipedia to be evolving and not etched in stone).  For example, an article in the New England Journal of Medicine, as long as it's understandable, I think it's a good source.  Cool Nerd (talk) 21:33, 22 March 2011 (UTC)

A draft:

"In occasional cases, even for healthy young adults, flu can cause either respiratory distress syndrome or pneumonia, which are manifest with a difficulty in breathing. In addition, there is a pattern in which a child (or presumably an adult) seems to be recovering and then relapses with high fever. This relapse can be bacterial pneumonia. And in general, in occasional cases, flu can cause either direct viral pneumonia and/or secondary bacterial pneumonia.Hospitalized Patients with 2009 H1N1 Influenza in the United States, April–June 2009, New England Journal of Medicine, Jain, Kamimoto, et al., Nov. 12, 2009.  This study found “only 73% of patients with radiographic evidence of pneumonia received antiviral drugs, whereas 97% received antibiotics.” [Discussion section, 8th paragraph].  It is recommended that such patients receive both."

Beginning symptoms are typically fever and dry cough
Science Watch, Hot Paper in Medicine, http://www.sciencewatch.com/dr/sci/10/jun13-10_3/ : "Emergence of a novel swine-origin influenza A (H1N1) virus in humans," by the Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team (F.S. Dawood, et al.), New England Journal of Medicine, 360(25): 2605-15, 18 June 2009. “ . . . The most common presenting symptoms were fever (94% of patients), cough (92%), and sore throat (66%);. . . ”

http://www.nejm.org/doi/full/10.1056/NEJMoa0903810 [summary] http://www.nejm.org/doi/full/10.1056/NEJMoa0903810#t=article  [full article]  See esp Table 1 which list symptoms.

[http://articles.cnn.com/2009-09-18/health/h1n1.staying.healthy_1_h1n1-seasonal-influenza-seasonal-flu?_s=PM:HEALTH Cold? Flu? H1N1? How can you tell the difference?], by Val Willingham CNN Medical Producer, Sept. 21, 2009. " .  .  .  According to the CDC seasonal flu and H1N1 symptoms consist of fever, more painful body aches, dry cough, diarrhea and severe fatigue. It's hard, without testing, to tell apart the seasonal strain of flu from the H1N1 variety.  .  .  "

Flu season: This year is different Prevention is key for what experts think will be the flu season of all flu seasons, Markian Hawryluk / The Bulletin, Last modified: September 17. 2009. The article also includes brief cartoons explaining symptoms.

In the first paragraph of our opening, we have: "Although it is often confused with other influenza-like illnesses, especially the common cold, influenza is a more severe disease than the common cold and is caused by a different type of virus."

That's good. Yet, in the Transmission section, we have a picture of a person sneezing. Wow. That's just not accurate. Cough is the common symptom with influenza. As a temporary fix, let's pull the picture from the Cough article, and perhaps later look for a better picture. Cool Nerd (talk) 18:27, 27 March 2011 (UTC)

I think this might be an example of wikipedia working well. I replaced a picture of a sneeze with a picture of a cough (17 March 2011). For coughing is (one of) the symptoms for influenza. And I used the picture from our 'Cough' wiki article. Orangemarlin (11 April 2011) deleted the picture of the boy coughing, stating that cough is just one symptom and this is actually a picture of a boy with pertussis. Orangemarlin is right on both counts. Now, the next step might be a picture of a person coughing from influenza, and stating that flu typically starts off with a dry cough (although if it advances to pneumonia, it's certainly not going to stay a dry cough). And a picture representing fever. Again, these are the two most common symptoms of influenza. So, I think we've had first improvement, second improvement, and potential for third improvement. Cool Nerd (talk) 23:14, 23 May 2011 (UTC)

Fever and Cough are most common symptoms
as a test run for including in our article: "(In a 2009 study regarding H1N1, the most common presenting symptoms were fever, which was present in 94% of patients, and cough, present in 92% of patients).(Science Watch, Thomson Reuters, Hot Paper in Medicine, Week of June 13, 2010, which in turn cites: "Emergence of a novel swine-origin influenza A (H1N1) virus in humans," by the Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team (F.S. Dawood, et al.), New England Journal of Medicine, 360(25): 2605-15, 18 June 2009.)


 * posted by Cool Nerd (talk) 20:04, 24 May 2011 (UTC)


 * Please do not assume that all strains of influenza virus give rise to the same symptoms. Some strains cause mild, often asymptomatic infections. Graham Colm (talk) 17:49, 27 May 2011 (UTC)


 * Excellent point. The question of people who are asymptomatic in the spread of influenza.  I'll see if I can look up some stuff.   Cool Nerd (talk) 22:31, 28 May 2011 (UTC)

Role of people who are asymptomatic or with mild cases in spread of influenza
Half of schoolchildren in some areas had swine flu: government scientists, Up to half of children in some areas have had swine flu even though they may not have shown symptoms, government scientists have found. The Telegraph (UK), By Rebecca Smith, Medical Editor, 21 Jan 2010.

“ .  .  .  Estimates were based on the numbers of people seeing their GP or contacting the flu line with symptoms but this did not capture the cases which were mild or had no symptoms, [emphasis added] the Health Protection Agency experts said. . .  ”

“ .  .  .  In an article published online in The Lancet medical journal Prof Elizabeth Miller and colleagues described how blood samples taken before and after the swine flu outbreak has found many more people had the disease. . .  ”

“ .  .  .  But in August and September the proportion of children aged up to four with H1N1 antibodies rose to one fifth in London and the West Midlands. Almost half of children aged between five and 14 had antibodies, they said. . .  ”

“ .  .  .  In a separate study it was found that because so many children were infected in the first wave that by the time the second wave hit, after the schools reopened in September, there was little impact the vaccine could make on the spread of the disease. . .  ”

“ .  .  .  supports the approach taken by government to vaccinate people at risk of complications. . .  ”


 * posted by Cool Nerd (talk) 17:34, 6 June 2011 (UTC)

World Health Organization, Europe, How to catch influenza? " .  .  .  Roughly 50% of all infections are, however, asymptomatic.  .  .  "

World Health Organization, Editorial, Influenza in the 21st century: a call for papers, Tim Nguyen,a Adrienne Rashforda & Charles R Penna, Bull World Health Organ 2011: " .  .  .  Human infection with influenza can vary from asymptomatic infection and acute self-limiting upper respiratory tract disease to serious complicated illness that may include exacerbation of other underlying conditions and severe viral pneumonia.  .  .  "

Linking technical information to what people already know
Okay, most people have heard of Tamiflu.

So, we have the following in the last paragraph of our lead, currently the very last sentence:

"Antiviral drugs can be used to treat influenza, with neuraminidase inhibitors being particularly effective."

I think it would make a good part even better to add the parenthetic comment (such as Tamiflu or Relenza)(World Health Organization, Global Alert and Response (GAR), Antiviral drugs for pandemic (H1N1) 2009: definitions and use, 22 December 2009. And here's an excerpt:

http://www.who.int/csr/disease/swineflu/frequently_asked_questions/antivirals/definitions_use/en/index.html “ .  .  .  These are the neuraminidase inhibitors oseltamivir and zanamivir, more commonly known by their trade names Tamiflu and Relenza. . .  ”

For something a little more technical on Relenza: http://apps.who.int/prequal/WHOPAR/WHOPARPRODUCTS/IN007part6v1.pdf

(And I’m sure there’s plenty of more technical publications on Tamiflu.)

Tell me what you think. And as always, standing offer, if you have the time, jump in, do some research, and help make a good article even better. :) Thanks.   Cool Nerd (talk) 18:35, 26 May 2011 (UTC)

Biondvax reports successful trial with universal flu vaccine, June 2011
BiondVax reports positive results for flu vaccine, Reuters, June 16, 2011. ' .  .  .  "We have confirmed, in what is to our knowledge the first Phase II study of a universal influenza vaccine ever conducted in the world, that the Multimeric-001 vaccine is not only safe and immunogenic on its own, but it also has the potential to enhance the performance of traditional strain-dependant flu vaccines," Ron Babecoff, BiondVax's CEO, said. . .  '

BiondVax to Present Phase IIa Results at 2011 BIO International Convention, FierceBiotech, May 31, 2011. ' .  .  .  BiondVax is currently in the final stages of collecting and analyzing the data regarding the immunogenicity of the vaccine, and will announce the final results of the trial prior to the presentation at BIO at the end of June. . .  ' <-- As of July 20, search of google news, I am not finding a follow up to this. Cool Nerd (talk) 16:40, 20 July 2011 (UTC)


 * And as a Sunday, July 3, I do not yet see a reference to a summary of this conference on Google news when I did a news search for "Universal Flu Vaccine."


 * And here's a link to the 2011 Bio International Convention, which ran from June 27-30, 2011. http://convention.bio.org/


 * And here's the Biondvax corporate site. http://www.biondvax.com/128084/Events---Presentations-1


 * And really, it could be like anything else, you're trying to do something new, and the steps may flow very smoothly. Or, there might be unexpected problems.  Cool Nerd (talk) 17:12, 3 July 2011 (UTC)

Other work towards universal flu vaccine.
The Telegraph, Universal flu vaccine a step closer, Stephen Adams, Medical Correspondent, 8 July 2011:

“ .  .  .  By putting the new antibody together with one they discovered two years ago, they hope to make a vaccine that protects against the vast majority of strains. “It would not only stop people catching a virus, they say, but also neutralise it in those already infected. . .  ”

“ .  .  .  Ian Wilson, professor of structural biology at the Scripps Research Institute in La Jolla, California, said a vaccine containing the two antibodies had "the potential to protect people against most influenza viruses". . .  ”

“ .  .  .  scientists from Scripps and Crucell, a Dutch pharmaceutical company, have found that viruses also contain common elements which vary much less. “Antibodies that lock on to these "binding sites" - technically called epitopes - should therefore be able to work year in, year out. . .  ”

“ .  .  .  Two years ago the team identified the antibody CR6261, which in mice has been proven to work against about half of flu viruses, including those from the H1 family. . .  ”

“ .  .  .  Now they have found another antibody, CR8020, which appears to work against H3 and H7 strains. “Their work has been published in the journal Science Express. . .  ”


 * posted by Cool Nerd (talk) 18:55, 10 July 2011 (UTC)

Science Magazine (Science Express), A Highly Conserved Neutralizing Epitope on Group 2 Influenza A Viruses, Abstract, Damian C. Ekiert, Robert H. E. Friesen, Gira Bhabha, et al., Science DOI: 10.1126/science.1204839, Published Online 7 July 2011 (Abstract only). “ .  .  .  The identification of VH1-69 antibodies that broadly neutralize almost all influenza A group 1 viruses constituted a breakthrough in the influenza field. Here, we report the isolation and characterization of a human monoclonal antibody CR8020 with broad neutralizing activity against most group 2 viruses. . . a highly conserved epitope in the HA stalk. . .  Thus, a cocktail of two antibodies may be sufficient to neutralize most influenza A subtypes and, hence, enable development of a universal flu vaccine and broad-spectrum antibody therapies.”
 * Please note: I am not a doctor.  I just take a variety of good sources and take an excerpt and/or summarize the source in a straightforward fashion.   Cool Nerd (talk) 19:32, 19 July 2011 (UTC)
 * I included a brief summary with these two references at the end of our Vaccination section. Cool Nerd (talk) 17:31, 20 July 2011 (UTC)

Tyler's grippe
US Grant suffered from "Tyler's grippe" apparently named after the president. Grant claimed his family was particularly susceptible to this. Other journals mention many deaths from this. It can obviously lead to pneumonia. But what would we call this flu today? Just some ordinary flu mutation? Probably should be listed someplace. I cannot find enough information to credibly document it. Student7 (talk) 01:11, 1 August 2011 (UTC)

Mathematics
I was going to tag this but the article had been locked.

An editor who seemed to know what he was doing was discussing the mathematics of propagation. Each person infecting 1.4 people, virus mutates and therefore burns itself out in 2 or 3 months. This seems like all good stuff, but is not evident from the math. Should another article be linked in describing the process? Or maybe the math figures left out of this one? Right now, not self-evident from the data presented.

One of the main problems right now is why the flu ever burns out. It would seem to me from the facts presented that the virus should stay ahead of prevention methods. Student7 (talk) 13:12, 7 October 2011 (UTC)

'Typical' flu season, percent of people symptomatic, percent of people asymptomatic?
I think a range of typical numbers is useful if we can find them. The following is a start. Cool Nerd (talk) 17:47, 10 May 2012 (UTC)

How to catch influenza?, Facts and figures, WHO, Regional Office for Europe.

“ .  .  .  Roughly 50% of all infections are, however, asymptomatic.

“In most cases, the influenza virus is transmitted from infected people coughing and sneezing. Droplets can settle on the mucosal surfaces of the upper respiratory tracts of susceptible people nearby (close contact, as defined by WHO, is about 1 m). . .  ”

“ .  .  .  The onset of symptoms occurs 18–72 hours after infection. The risk for transmission from adults is greatest during the first 2 days of illness, but lasts up to 7 days after onset of the disease. Children are often carriers because they are more often asymptomatic and shed the greatest amount of virus over a longer period of time (up to 21 days from illness onset).”

---

Time Lines of Infection and Disease in Human Influenza: A Review of Volunteer Challenge Studies, American Journal of Epidemiology, Carrat, Vergu, Ferguson, Lemaitre, Cauchemez, Leach, Valleron, 167 (7): 775-785, 2008.

“ .  .  .  Modeling studies used frequencies of between 30 percent and 50 percent. However, these percentages come from pre- and post-influenza-season serologic studies, and they may therefore be subject to recall bias when individuals were asked whether they had had influenza-like illness during winter. . .  ”

“ .  .  .  In almost all studies, participants were individually confined for 1 week. . .  ”

“ .  .  .  In this latter case, however, the results were controversial: Volunteers were placed in isolation in groups of three, so that reinfection cannot be excluded. . .  ”

“ .  .  .  On the basis of a large review of experimental influenza virus infection of healthy volunteers, we found that average shedding of influenza virus increased during the first day after inoculation, consistently peaked on the second day, and lasted less than 5 days. One in three infected participants did not develop any clinical illness. Experimental influenza virus infection caused a mild disease, with mainly upper respiratory symptoms. Fever was observed in one third of participants, and lower respiratory symptoms, including cough, occurred in one in five participants. . .  ”

“ .  .  .  In a prospective survey of households where an influenza-positive index patient was identified, fever or feverishness was found in only 16–32 percent of household contacts who developed an acute illness within 5 days of inclusion. . .  ”

“ .  .  .  Finally, several reports suggest that, compared with otherwise healthy adults, children can shed virus earlier before the illness begins and for a longer period once the illness starts. . .  ”


 * This is a meta-analysis of a number of studies, which shows that approximately 1/3 of people who get influenza are asymptomatic.


 * For people who do get sick, Figure 5 shows that the curve for virus shedding and infectiousness runs about one day ahead of symptoms (at least at the beginning), and that's a problem. Maybe still time to avoid going out in public during the day 2 peak, as well as days 3 and 4.  Perhaps.  Cool Nerd (talk)

http://aje.oxfordjournals.org/content/167/7/775/F5.expansion.html

Other potential topics and articles.
Study: Mexico's H1N1 mortality rose as antiviral use dropped, CIDRAP News, Robert Roos, News Editor, Apr 23, 2012.

“ .  .  .  The investigators found that about 50% of H1N1 patients received antiviral treatment during the spring and summer waves, but the rate dropped to 9% in the fall wave, according to the report, published in BMC Infectious Diseases. . .  ”


 * Certainly important for the history of H1N1. Cool Nerd (talk) 17:57, 10 May 2012 (UTC)

Danger sign if a child seems to be recovering and then relapses with high fever.
Report Finds Swine Flu Has Killed 36 Children, New York Times, DENISE GRADY, September 3, 2009:

“ .  .  .  In children without chronic health problems, it is a warning sign if they seem to recover from the flu but then relapse with a high fever, Dr. Frieden said. The relapse may be bacterial pneumonia, which must be treated with antibiotics. . .  .  ”


 * Okay, so from this, doesn't necessarily mean that it is pneumonia, but it might be. Cool Nerd (talk) 16:41, 16 May 2012 (UTC)

Trouble breathing --> obvious danger sign.
Transcript of virtual press conference with Gregory Hartl, Spokesperson for H1N1, and Dr Nikki Shindo, Medical Officer, Global Influenza Programme, World Health Organization, 12 November 2009:

‘ .  .  .  2. Secondly, people who are not from the at-risk group but who have persistent or rapidly worsening symptoms should also be treated with antivirals. These symptoms include difficulty breathing and a high fever that lasts beyond 3 days.

‘3. Thirdly, people who have already developed pneumonia should be given both antivirals and antibiotics, as we have seen that, in many severe cases of H1N1-caused illness, bacterial infection develops. . .  ’


 * posted by Cool Nerd (talk) 16:52, 16 May 2012 (UTC)

Influenza can cause either direct viral or secondary bacterial pneumonia.
Hospitalized Patients with 2009 H1N1 Influenza in the United States, April–June 2009, New England Journal of Medicine, Jain, Kamimoto, et al., Nov. 12, 2009:

" .  .  .  In our study, only 73% of patients with radiographic evidence of pneumonia received antiviral drugs, whereas 97% received antibiotics. In the absence of accurate diagnostic methods, patients who are hospitalized with suspected influenza and lung infiltrates on chest radiography should be considered for treatment with both antibiotics and antiviral drugs.  .  .  " (Discussion, 8th paragraph)


 * posted by Cool Nerd (talk) 16:57, 16 May 2012 (UTC)

1918-1919 Pandemic
Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic, Emerging Infectious Diseases (posted by CDC), John F. Brundage and G. Dennis Shanks, Vol. 14, No. 8, August 2008.

“Deaths during the 1918–19 influenza pandemic have been attributed to a hypervirulent influenza strain. Hence, preparations for the next pandemic focus almost exclusively on vaccine prevention and antiviral treatment for infections with a novel influenza strain. However, we hypothesize that infections with the pandemic strain generally caused self-limited (rarely fatal) illnesses that enabled colonizing strains of bacteria to produce highly lethal pneumonias. . .  ”


 * posted by Cool Nerd (talk) 18:39, 18 May 2012 (UTC)

Signs & Symptoms
First off, approximately 33% of persons with influenza are asymptomatic should be Approximately 33% of people with influenza are asymptomatic because 'first off' isn't very encyclopaedic, and 'people' is the preferred plural in this context: Fowler's states that 'persons' should be used when the number of people is known or when there is an emphasis on individuality, neither of which is present here. Furthermore, I don't think that the sentence should be its own paragraph; the next sentence should begin immediately adjacent. Thanks! 109.149.73.110 (talk) 20:08, 26 May 2012 (UTC)
 * Agreed and changed. Left separate paragraph as it doesn't belong with the other content. Yobol (talk) 20:14, 26 May 2012 (UTC)
 * I've reread it and agree. Thanks for correcting so quickly. 109.149.73.110 (talk) 11:27, 27 May 2012 (UTC)

Swollen glands
Is there any reason swollen glands isn't listed under signs and symptoms? It's not mentioned anywhere in the article. Adrian J. Hunter(talk•contribs) 08:05, 20 August 2012 (UTC)

Swine Flu
"In 2009, a swine-origin H1N1 virus strain commonly referred to as 'swine flu' caused the 2009 flu pandemic, but there is no evidence that it is endemic to pigs (i.e. actually a swine flu) or of transmission from pigs to people, instead the virus is spreading from person to person.[212][213]"

To be more grammatically correct, the sentence should be changed to:

"In 2009, a swine-origin H1N1 virus strain commonly referred to as 'swine flu' caused a flu pandemic. However, there is no evidence that it is endemic to pigs (i.e. a true swine flu) or transmitted between pigs and people; instead, the virus is spreading from person to person. [212][213]"

Take what you will from this suggestion. Firstly, it is repetitive to say "... caused the 2009 flu pandemic," as the year in which this occurred has been previously stated in the sentence. Second, the sentence in its current state is a run-on and reads very poorly; a grammatical error such as this damages the integrity of the section, and the article itself. I have included in my suggestion to alleviate this problem such changes as breaking the current sentence into two parts, adding a semicolon rather than a comma between "people" and "instead", and some minor grammatical changes. Again, take from this suggestion what you will.

XPPaulsonx (talk) 20:21, 27 November 2012 (UTC)

Vaccination section sounds like it was written by vaccine deniers
Breaks Wkipedia policy (it is not non-biased). Only provides sources for statements questioning efficacy of vaccine. Does not bother to cite current settled knowledge that the vaccine completely PREVENTS the illness 70%+ of the time. The article makes it sound as if the flu shot only reduces "symptoms" of the flu. Articles like this contribute to loss of herd immunity and more deaths and serious illness from flu. Please correct ths bias! — Preceding unsigned comment added by 76.182.88.171 (talk) 18:21, 22 December 2012 (UTC)
 * I don't see a bias. A reliable source is needed to substantiate the claim that a vaccine completely prevents the illness 70% of the time. A recent Cochrane systematic review concluded "Influenza vaccines are efficacious in preventing cases of influenza in children older than two years of age...[but] reliable evidence on influenza vaccines is thin [and] there is evidence of widespread manipulation of conclusions.
 * Yes I was surprised when I discovered that the evidence for vaccination was so poor. While there is the support of expert opinion (WHO and CDC) the trial data is weak. If you can find other high quality references we would be happy to look at them. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 03:26, 23 December 2012 (UTC)

Dead links
There are problems with the refs using these urls: These should be fixed or replaced.-- FutureTrillionaire (talk) 02:35, 12 January 2013 (UTC)
 * http://jmii.org/content/pdf/v39n1p4.pdf
 * http://www.who.int/csr/disease/influenza/2007northreport.pdf
 * http://msc.tigr.org/infl_a_virus/index.shtml
 * http://www.jstage.jst.go.jp/article/bpb/28/3/399/_pdf

Aerosols vs. Contact (Influenza Main Topic)
I am unclear what the sentence "Airborne aerosols have been thought to cause most infections, although which means of transmission is most important is not absolutely clear." is supposed to be saying.

If the sentence means to compare airborne vs. contact (i.e. bird droppings), and there is some disagreement as to whether contact or aerosols is the predominant vector for infection, then airborne shouldn't be "thought to cause most" infections. On the other hand, if we are to take "Airborne aerosols have been thought to cause most infections" on its face, then what does "important" in that sentence mean? Perhaps the author wanted to say "frequent" instead of "important"?

If the author is aware of a citation that shows some percentage of infections caused by contact vs. aerosols, or research showing the inability to quantify which means is most frequent, then this should be cited.

If the sentence was to remain, I would like to have it say "Airborne aerosols have been thought to cause most infections, though the frequency of infections caused by contact alone is not absolutely clear."

--AmbidexterNH (talk) 23:44, 19 January 2013 (UTC)AmbidexterNH

Additional source(s) on work toward universal flu vaccine.
http://www.in-pharmatechnologist.com/Drug-Delivery/Universal-flu-vaccine-in-reach-says-NIH <-- including the intriguing idea that such a vaccine may only work in the very young.


 * posted by Cool Nerd (talk) 19:23, 2 April 2013 (UTC)

http://news.ninemsn.com.au/health/2013/03/12/15/55/universal-flu-vaccine-may-be-close-study

Treatment: Probiotics
Has this been considered? http://www.nature.com/srep/2013/130328/srep01563/full/srep01563.html

--Vocasla (talk) 13:55, 6 April 2013 (UTC)
 * We prefer to use secondary sources. Graham Colm (talk) 17:50, 6 April 2013 (UTC)


 * I think probiotics is a wave of the future. And may well explain why some people in a given year get influenza and other people don't.  In people who don't get it, much of the available "real estate" in the respitory tract may be already taken up by neutral and/or helpful bacteria.  (And yes, I am aware that influenza is caused by a virus.)


 * That said, Graham is largely correct. We want the main line of our sources to be solid review articles, perhaps medical textbooks like Harrison's, and the like.  Where I might differ with others, is that I think it's okay to also give links to primary sources.  We just shouldn't use these for the main flow of our article.


 * I AM NOT A DOCTOR. Not even close.  I have spent most of my working career in sales and retail management.  And I have my intellectual interests I like to pursue in my free time.  I got very interested in the whole H1N1 swine flu pandemic which started around April 2009, and I followed it closely.  At times, I think I was the only wikipedia researcher-editor who invested the time to read the World Health Organization weekly press conferences on H1N1.  So, no, I'm not an expert but I do put the time in.  And yes, I do think it's more valuable to think of ourselves as researchers-editors, and not simply as editors.  Cool Nerd (talk) 20:47, 9 April 2013 (UTC)

new H7N9, and possibility of human-to-human transmission?
Deadly Bird Flu Spreading in China, Unclear How, ABC News, Katie Moisse, April 18, 2013.

http://abcnews.go.com/Health/bird-flu-spreads-china-unclear/story?id=18987118

"Health officials in China are scrambling to uncover how multiple members of three families in Shanghai and a young boy and girl from neighboring homes in Beijing became infected with a new strain of bird flu. .  .  "


 * posted by Cool Nerd (talk) 23:34, 23 April 2013 (UTC)

-

Background and summary of human infection with influenza A(H7N9) virus– as of 5 April 2013, WHO.

" .  .  .  Two family clusters have been reported.  .  .  "

" .  .  .  two of the cases in that cluster have not been laboratory confirmed and there is no other evidence pointing toward sustained transmission among people.  .  .  "

" .  .  .  Some viruses are able to cause limited human-to-human transmission under condition of close contact, as occurs in families, but are not transmissible enough to cause larger community outbreaks.  .  .  "


 * posted by Cool Nerd (talk) 23:34, 23 April 2013 (UTC)

Host Cell
The article only once, a little haphazardly, mentions that the target for the virus is epithelial cells. Maybe this could be better emphasized/clarified? — Preceding unsigned comment added by 206.12.34.105 (talk) 01:53, 25 July 2013 (UTC)

Diagnosis
There is no section on diagnosis? Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:21, 17 July 2013 (UTC)
 * I checked the history to see if any section had that name at any time in the past. When the article was promoted to featured status in 2006 it had no such section, and when I spot-checked 2010, 2011, and 2012, I also saw no such section.  Blue Rasberry    (talk)   15:36, 25 July 2013 (UTC)

Natural compound
Not sure about "The natural compound palmitoylethanolamide has been evaluated in 6 placebo-controlled randomized clinical studies and these studies were recently reviewed. Palmitoylethanolamide seemed to be effective and safe in both the prophylaxe as well as in the treatment of flu and respiratory disorders.As side effects were absent, this compoud, available as a foodsupplement seems to be a new alternative, especially for those unwilling to accept vaccinations or the above described antivirals." The ref is from a none pubmed indexed journal. The studies reviewed are from the 1970s. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:58, 8 September 2013 (UTC)

U.S. deaths
Can somebody tell me why the U.S. deaths have been removed from the article? I realize that Wikipedia maintains an international perspective, but the U.S. numbers are much more accurate than the worldwide numbers, and they're often used as the basis of for example cost/benefit calculations in the journals. --Nbauman (talk) 17:38, 14 November 2013 (UTC)

Mortality rate
The 4th paragraph from the top states: "Influenza spreads around the world in seasonal epidemics, resulting in about three to five million yearly cases of severe illness and about 250,000 to 500,000 yearly deaths." This is about a 10% mortality rate. However down below in the middle of the article, in the History / Pandemics section it says: "The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%. 97.116.44.1 (talk) 02:31, 29 December 2013 (UTC)

First literary reference
I'd like to suggest a change to this line, "The symptoms of human influenza were clearly described by Hippocrates roughly 2,400 years ago.[167][168]"

Could I suggest these tweaks that I think might be more accurate with regard to the source: "Influenza-like symptoms are described by Hippocrates (or one of his disciples) in reporting what has come to be known as "the cough of Perinthus" around 400BC, referring to coughs, fevers, and increased mortality among the already sick."

I've never done this Talk before but here's a reference: http://books.google.com/books?id=tzRwRmb09rgC&lpg=PA79&ots=hP7Wbh09tS&dq=the%20Cough%20of%20Perinthus&pg=PA80#v=onepage&q=the%20Cough%20of%20Perinthus&f=false

If this whole post is in the wrong place just let me know, cheers.

Russell Ward Ausrussell (talk) 07:52, 5 January 2014 (UTC)

Wikipedia hits help track flu spread
Wikipedia hits help track flu spread WWGB (talk) 07:07, 18 April 2014 (UTC)

Semi-protected edit request on 19 April 2014

 * Wikipedia Proves Useful for Tracking Flu

Sujoyhnkc (talk) 08:27, 19 April 2014 (UTC)
 * Yes this is interesting. We need a high quality secondary source before we really comment on it. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 08:30, 19 April 2014 (UTC)

There are six genera of the family Orthomyxoviridae, not five.
The virus taxonomy released by ICTV in 2013 shows there are six genera in the Family Orthomyxoviridae, under the unassigned Order. http://www.ictvonline.org/virusTaxonomy.asp

Inad1563 (talk) 09:22, 6 June 2014 (UTC)

The relationship between influenza and the common cold
This line appears to be inconsistent with what I've read in Wikipedia's common cold article:

"Although it is often confused with other influenza-like illnesses, especially the common cold, influenza is a more severe disease caused by a different type of virus.[1]"

The common cold article's virology section says influenza viruses are implicated in 10-15% of cold cases. The line above implies that influenza is caused by a different type of virus than the common cold, and that the conditions are distinct, which may be incorrect in some cases.

I would appreciate it if someone with some expertise in this area could edit these articles to clarify the relationship between common cold and influenza.
 * Good point. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:34, 15 August 2014 (UTC)

Respiratory infection
10.1016/S2213-2600(14)70131-6 - The role of influenza in the severity and transmission of respiratory bacterial disease, Lancet Resp Med JFW &#124; T@lk  08:27, 28 August 2014 (UTC)

Semi-protected edit request on 29 September 2014
Please change in the pandemic chart on the pandemic severity level NA to N/A because that is proper grammar.

Ben9583 (talk) 01:32, 29 September 2014 (UTC)
 * Yes check.svg Done Cannolis (talk) 03:19, 29 September 2014 (UTC)

Semi-protected edit request on 4 December 2014
There is a grammatical error: "As the virus can be inactivated by soap frequent hand washing reduces the risk of infection." I suspect this should read: "As the virus can be inactivated by soap. Frequent hand washing reduces the risk of infection.

Sethpool (talk) 23:13, 4 December 2014 (UTC)
 * Thanks, I have changed the sentence to "Frequent hand washing reduces the risk of infection because the virus is inactivated by soap." Graham Beards (talk) 23:27, 4 December 2014 (UTC)

Grammatical error
In the second paragraph, there is a grammatical error.

"It can also likely be spread by touching surfaces contaminated by the virus and than touching their mouth or eyes."

Should read something like...

"It is also likely spread by touching surfaces contaminated by the virus, and then touching the mouth or eyes."

Take whatever liberties you wish with the wording I chose, the important change is that the "than" should be a "then". :p — Preceding unsigned comment added by 128.118.28.38 (talk) 18:09, 5 December 2014 (UTC)
 * by Graham Beards. Thanks, Adrian J. Hunter(talk•contribs) 04:06, 6 December 2014 (UTC)

Change Word
Under Replication.. No need to use the word Elucidate. Its just going to obfuscate. — Preceding unsigned comment added by 50.120.220.25 (talk) 18:56, 17 December 2014 (UTC)

Semi-protected edit request on 16 September 2015
death rate form spanish flu is not 2% but 20%! table data is wrong

2A02:1810:9537:DD00:E0FB:F506:1B9C:7271 (talk) 14:19, 16 September 2015 (UTC)
 * Red information icon with gradient background.svg Not done for now: you didn't provide a source and I don't have access to the one given in the article so I can't make this change. However, our Spanish Flu article does give a case-fatality ration of "10 to 20%". I will post a note at WP:MEDICINE to have this looked into. Thanks for bringing this up. Ivanvector 🍁 (talk) 14:56, 16 September 2015 (UTC)
 * From an admittedly quick read, the cited Nature article doesn't actually give a case fatality rate. It does say "The case fatality proportion (CFP) was ten times higher than in all other influenza pandemics...", citing "Nicholson, K., Webster, R. G. & Hay, A. J. Textbook of Influenza (Blackwell Science, Malden, Massachusetts, 1998)" and "Frost, W. H. Statistics of influenza morbidity with special reference to certain factors in case incidence and case fatality. Public Health Rep. 35, 584−597 (1920)".  The authors of the Nature article also assumed a CFP of 2% for their own modelling.
 * This article, already cited in the fourth paragraph of Influenza, states "Case-fatality rates were >2.5%, compared to <0.1% in other influenza pandemics". Adrian J. Hunter(talk•contribs) 15:26, 16 September 2015 (UTC)

Improving definition in intro
It currently says:

Three types of influenza affect people.[4] Usually, the virus is spread through the air from coughs or sneezes.

The first of these sentences should say "three types of influenza viruses affect people, called Type A, Type B, and Type C".

(In addition, the first line says it is caused by "the influenza virus" - it would be better if it said "a" instead of "the".) Ping User:Doc_James Hildabast (talk) 23:58, 17 November 2015 (UTC)
 * User:Hildabast done Doc James  (talk · contribs · email) 00:13, 18 November 2015 (UTC)

introduction
I would just add at the beginnig that it is an infectious diseasse of the respiratory system — Preceding unsigned comment added by 77.254.147.94 (talk) 13:19, 29 December 2015 (UTC)

under external links - Outbreak Alerts is a website for sale ... — Preceding unsigned comment added by 108.233.85.123 (talk) 20:46, 29 December 2015 (UTC)

Antivirals review
Influenza is missing coverage of polymerase inhibitors (favipiravir) as a class of influenza antivirals.  Seppi  333  (Insert 2¢) 04:42, 10 January 2016 (UTC)

H7N8 Avian Influenza
There is a new avian influenza confirmed in the United States. USDA information below..... it should be addressed in this article, but I do not have permissions to edit (its semi-protected). Information below:

https://www.aphis.usda.gov/wps/portal/aphis/newsroom/news/sa_news/sa_by_date/newsroom-2016/newsroom-january-2016/ct-hpai-indiana-turkeys/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfGjzOK9_D2MDJ0MjDzdXUyMDTzdPA2cAtz8jT1dTPULsh0VAbiDHEw!/

USDA Confirms Highly Pathogenic H7N8 Avian Influenza in a Commercial Turkey Flock in Dubois County, Indiana Last Modified: Jan 15, 2016 Print Contacts: Andrea McNally (202)799-7033 andrea.c.mcnally@aphis.usda.gov Lyndsay Cole (970)494-7410 lyndsay.m.cole@aphis.usda.gov

WASHINGTON, January 15, 2016 -- The United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed the presence of highly pathogenic H7N8 avian influenza (HPAI) in a commercial turkey flock in Dubois County, Indiana. This is a different strain of HPAI than the strains that caused the 2015 outbreak. There are no known cases of H7N8 infections in humans. As a reminder, the proper handling and cooking of poultry and eggs to an internal temperature of 165 ˚F kills bacteria and viruses, including HPAI.

Samples from the turkey flock, which experienced increased mortality, were tested at the Indiana Animal Disease Diagnostic Laboratory at Purdue University, which is a part of USDA’s National Animal Health Laboratory Network, and confirmed by USDA this morning. APHIS is working closely with the Indiana State Board of Animal Health on a joint incident response. State officials quarantined the affected premises and depopulation of birds on the premises has already begun. Depopulation prevents the spread of the disease. Birds from the flock will not enter the food system.

As part of existing avian influenza response plans, Federal and State partners are working jointly on additional surveillance and testing in the nearby area. The rapid testing and response in this incident is the result of months of planning with local, state, federal and industry partners to ensure the most efficient and effective coordination. Since the previous HPAI detections in 2015, APHIS and its state and industry partners have learned valuable lessons to help implement stronger preparedness and response capabilities. In September, APHIS published a HPAI Fall Preparedness and Response Plan that captures the results of this planning effort, organizing information on preparatory activities, policy decisions and updated strategy documents. The United States has the strongest AI surveillance program in the world, and USDA is working with its partners to actively look for the disease in commercial poultry operations, live bird markets and in migratory wild bird populations.

Anyone involved with poultry production, from the small backyard to the large commercial producer, should review their biosecurity activities to assure the health of their birds. To facilitate such a review, a biosecurity self-assessment and educational materials can be found at http://www.uspoultry.org/animal_husbandry/intro.cfm

In addition to practicing good biosecurity, all bird owners should prevent contact between their birds and wild birds and report sick birds or unusual bird deaths to State/Federal officials, either through their state veterinarian or through USDA’s toll-free number at 1-866-536-7593. Additional information on biosecurity for backyard flocks can be found at http://healthybirds.aphis.usda.gov.

Additional background Avian influenza (AI) is caused by an influenza type A virus which can infect poultry (such as chickens, turkeys, pheasants, quail, domestic ducks, geese and guinea fowl) and is carried by free flying waterfowl such as ducks, geese and shorebirds. AI viruses are classified by a combination of two groups of proteins: hemagglutinin or “H” proteins, of which there are 16 (H1–H16), and neuraminidase or “N” proteins, of which there are 9 (N1–N9). Many different combinations of “H” and “N” proteins are possible. Each combination is considered a different subtype, and can be further broken down into different strains. AI viruses are further classified by their pathogenicity (low or high)— the ability of a particular virus strain to produce disease in domestic chickens. RGRicklefs (talk) 00:36, 19 January 2016 (UTC)

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Semi-protected edit request on 20 January 2016
Please change this statement: According to the CDC, rapid diagnostic tests have a sensitivity of 70–75% and specificity of 90–95% when compared with viral culture. To According to the CDC, rapid diagnostic tests have a sensitivity of 50-70% and specificity of 90–95% when compared with viral culture but their performance is highly variable depending on a number of factors associated with prevalence of the infection at the time of testing.

109.147.82.193 (talk) 09:06, 20 January 2016 (UTC)
 * Pictogram voting comment.svg Note: Due to FA, I would like a second editors input here --allthefoxes (Talk) 16:39, 20 January 2016 (UTC)
 * Yes check.svg Done The original sentence in the article was unsourced. The edit requester provided a WP:MEDRS compliant source to support the request. Having verified the info in the source matches the requested wording by the requester, I have made the requested changes.  Eve rgr een Fir  (talk) Please &#123;&#123;re&#125;&#125; 23:44, 2 February 2016 (UTC)

Semi-protected edit request on 3 November 2016
Suggestion 1 - addition of link to Flu News Europe - a weekly update during the influenza season covering 53 countries.

Suggestion 2 - Link to European Influenza Surveillance Scheme is broken. I believe this should be replaced by a link to European Influenza Surveillance Network (EISN)

Suggestion 3 - Link to ERS Online Course on Influenza is broken - should this be http://www.ers-education.org/events/courses/influenza-2009-(jointly-organised-with-eswi).aspx ?

Suggestion 4 - Link to Recombinomics – What's New is broken.

Cdfj (talk) 13:52, 3 November 2016 (UTC)
 * Padlock-silver-open.svg Not done: According to the page's protection level you should be able to edit the page yourself. If you seem to be unable to, please reopen the request with further details. — Andy W. ( talk ) 00:19, 4 November 2016 (UTC)

Dead links and others
Hi, I'm working on translating this article into Chinese, but find some problems as listed below:
 * At least 10 dead links.
 * Some sentences do not have citations or citations that contain corresponding contents to support the argument, for example:
 * but a flu can be identified by a high fever with a sudden onset and extreme fatigue.
 * People over 50 years old, ..... are more likely to get complications from influenza, such as pneumonia, bronchitis, sinus, and ear infections.
 * "Society and culture" section seems outdated, which does't have information after 2009.

I think it's a great and important article, but may need thorough examination after its promotion to featured article 10 years ago. I'll try to solve these problems after translation is done, but it'll be great if someone can help solve them in advance, because I'm only a medical student but not an expert in virology or infectious disease. It's relatively a tough work for me to update a whole section like "Society and culture." Many thanks.--Iv0202 (talk) 19:32, 28 December 2016 (UTC)
 * If you could mark some of the dead links with a tag, and some of the sentences you're concerned about with  tag, it'll be easier for us to find and help with them. Thanks and happy editing! Ajpolino (talk) 19:50, 28 December 2016 (UTC)
 * Thanks for quick reply. I've marked some of them. --Iv0202 (talk) 20:35, 28 December 2016 (UTC)
 * I think I got all the dead links you marked. One of them (titled "WHO Confirmed Human Cases of H5N1") is just a list of documents. It doesn't necessarily backup the claim about seasonality it cites (and it didn't when the ref was placed in October 2006 either). I updated the URL anyway in case that's useful to someone. In places where the URL was dead but there was a valid DOI, I just removed the URL (the DOI is a permanent identifier which will point to the URL where the object is). Haven't look at the citation needed tags yet. May not have the time for a few days, but hopefully someone else will jump in. Hope that helps! Happy translating! Ajpolino (talk) 21:29, 28 December 2016 (UTC)
 * Thanks a lot. Now the remaining works are the sentences marked citation needed and the update of section Society and Culture. Hope others can help =) --Iv0202 (talk) 01:54, 31 December 2016 (UTC)

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Lancet seminar
10.1016/S0140-6736(17)30129-0 JFW &#124; T@lk  16:42, 14 August 2017 (UTC)

Why is the section on Neuraminidase inhibitors so bad?
It didn't tell me what they are. I would have liked to see, "neuraminidase inhibitors act on the protein X-and-so that buds the newly-formed virus off the host cell...." The sort of thing that would tell me what a neura inhibitor actually is.

Instead it's all about why the author thinks they are bad. It sounds biased to me, and I'm a random user with no prior knowledge. The same sentence "the benefits of neuraminidase inhibitors in those who are otherwise healthy..." appears twice in this article, a third time on the page for neuraminidase inhibitors. I think someone is spouting their personal belief. -- Unsigned


 * It appears that in 2013, a user threw out the old NAI section and inserted a rather opinionated conclusion. Though I'm not sure that it would classify as personal as I believe it reflected recent findings of the time; and the conclusions of one center specifically. Perhaps you could salvage some of the introduction from before the rewrite. Although I think one should avoid repeating the general descriptions found on the dedicated Neuraminidase inhibitor page. C. lorenz (talk) 19:13, 8 September 2017 (UTC)


 * About the strongly-voiced conclusion echoed throughout the page, I would say it's a somewhat controversial point to this day. Perhaps the section should reflect this. Roche indeed withheld data and independent analyses did not find the drug to be as effective as tentatively advertised. Some flack is well deserved for this reason. However, even those studies indicated effects other than shortened disease. In addition to their trials, there is extensive treatment data since. Reviews not restricted to the Roche trials indeed indicate other significant effects, e.g. prevention of clinical infections and reduction in hospital admission. WHO changed their recommendation this summer about stockpiling antivirals as essential for influenza pandemics, though still recommending it for treating severe cases. This was likely inspired by statements and reviews originating from the BMC, which in turn appear largely based on the Roche trials. More recently, the ECDC released a broader literature review. Therein, it is indeed concluded that there is evidence for drug effectiveness beyond shortened disease. Along with support for the broad use as pandemic treatment and prevention. I would say that these strong statements on the page do not appear to be true given present understanding. C. lorenz (talk) 19:13, 8 September 2017 (UTC)

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Error: "soap inactivates flu virus"
The error occurs in the lead section: 3rd paragraph, 1st sentence.

The linked study is a meta-analysis, examining a large number of studies (215, to be exact) to assess methods to reduce viral transmission. So the referenced paper isn't even an individual study examining specifically whether soap inactivates respiratory viruses. And the meta-analysis in the linked study absolutely DOES NOT say that the flu virus can be inactivated by soap. (What!) If so, it would be headline news. To the best of my knowledge, no study ever has (or ever will) prove this. From the linked study's abstract: OBJECTIVES: MAIN RESULTS: AUTHORS' CONCLUSIONS:
 * To review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.
 * Excerpt: "...The highest quality cluster-RCTs suggest respiratory virus spread can be prevented [NOT that viruses are inactivated] by hygienic measures, such as handwashing, especially around younger children."
 * Also note: "Adding virucidals or antiseptics to normal handwashing to decrease respiratory disease transmission remains uncertain." So the statement that "soap inactivates virus" could not have been referring to the presence of virucides/antiseptics in said soap, at least not using statements from this study as a reference.
 * Simple and low-cost interventions would be useful for reducing transmission of epidemic respiratory viruses.

Therefore, the unsupported original statement, "Frequent hand washing reduces the risk of infection because the virus is inactivated by soap" was changed to "Frequent hand washing reduces the risk of viral transmission", which is the finding based on the referenced study.

From the chart at the top of this talk page, thousands of people have been reading this article daily, and some may have read this erroneous statement and believed it. Just because someone makes a statement and provides a link, doesn't mean the link is a good one; in this case, even though the link is a good one, it didn't actually support the alleged statement. So, it's always best to check. Cheers! ~ Big universe (talk) 04:58, 16 October 2017 (UTC)
 * It has long been known that enveloped viruses are inactivated by soap. It destroys the lipid membrane (envelope). Graham Beards (talk) 06:19, 20 October 2017 (UTC)

Influenza A and Influenza B
Should this article say that the influenza A virus is more serious than the influenza B virus, as mentioned on the programme "Inside Health" on BBC Radio Four on January 9 2018?Vorbee (talk) 21:12, 9 January 2018 (UTC)

There are two lineages of Influenza B
Regarding Influenza B, there are two known lineages: Yamagata and Victoria. The article is misleading relative to this.

Source: Differentiation of Influenza B Virus Lineages Yamagata and Victoria by Real-Time PCR Barbara Biere*, Bettina Bauer and Brunhilde Schweiger J. Clin. Microbiol. April 2010 vol. 48 no. 4 1425-1427 Gutsaac (talk) 23:00, 1 March 2018 (UTC)

Influenza di freddo
Regarding this edit by, I used WP:WIKIBLAME to find this edit, which is when the term was originally added to this article. The IP who added it has no other history. Apparently "freddo" really does mean "cold" in latin, so I think this is legit. Adrian J. Hunter(talk•contribs) 01:03, 24 March 2018 (UTC)

Prognosis: Risk factors
Hi,

I think the prognosis section could have some clarifications with references?

Rather than: 'Influenza's effects are much more severe and last longer than those of the common cold.'

I'd suggest: 'Influenza's effects MAY/CAN be much more severe and last longer than those of the common cold, although the majority of influenza infections are asymptomatic'

ref: Hayward AC, Fragaszy EB, Bermingham A, et al. Comparative community burden and severity of seasonal and pandemic influenza: Results of the Flu Watch cohort study. Lancet Respir Med 2014; 2: 445–54.

Also risk factors: "Pregnant women and young children are also at a high risk for complications.[147]" is contrary to a big systematic review (Mertz D, Kim TH, Johnstone J, et al. Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ 2013; 347: f5061--f5061.) which found scant evidence for pregnancy as a risk factor, so you might want to caveat pregnancy.

You could add child specific risk-factor information: "Asthma and neurological conditions are risk factors for influenza-related complications in children" ref : https://www.cambridge.org/core/journals/epidemiology-and-infection/article/risk-factors-for-influenzarelated-complications-in-children-during-the-200910-pandemic-a-uk-primary-care-cohort-study-using-linked-routinely-collected-data/B3DD460F6DA441B1D4F685F91229482F

Thanks! — Preceding unsigned comment added by Grinthreyhound (talk • contribs) 16:46, 14 May 2018 (UTC)

Material removed from elsewherw
I just cut down two very similar sections in Influenzavirus C [//en.wikipedia.org/w/index.php?title=Influenzavirus_C&diff=prev&oldid=866621962] and Influenzavirus D [//en.wikipedia.org/w/index.php?title=Influenzavirus_D&diff=prev&oldid=866622378] since as I said in my edit summaries, it seems pointless to go into so much detail on vaccinations for two genuses for which vaccinations don't really exist. Although this article already seems to have a developed section and we have a main article, I'm just noting it here in case anyone feels the info there would be useful somewhere else. Nil Einne (talk) 13:54, 31 October 2018 (UTC)

Removal of encephalitis reference
The removed reference by Meijer et al. calls itself a "comprehensive review of the literature of IAE in adults". I think editors may be looking at the article title only and assuming that it's a primary source, rather than looking at its content. DrKay (talk) 14:56, 9 November 2018 (UTC)

Disease frequency is misleading as listed.
This should read '3-5 million severe cases' according to source currently provided. Actual frequency of influenza infections would be in the billions per year - Dave DeLaurant — Preceding unsigned comment added by 2601:205:3:AD60:9966:F790:16A7:C13D (talk) 18:33, 24 January 2019 (UTC)

Our readers are not medical professionals; hedging language does not make for clear English communication
For example, from our Vaccination section: " . . while it also appears to decrease the rate of influenza in healthy children over the age of 2. . " We can be a lot more definite. (And vaccines may also help children under 2. The following review article simply couldn't find enough studies to really go on.)




 * Inactivated vaccines


 * "Compared with placebo or no vaccination, inactivated vaccines reduce the risk of influenza in children aged 2 to 16 years from 30% to 11% (RR 0.36, 95% CI 0.28 to 0.48; 1628 children; high‐certainty evidence), .  .  "

Again, a review article, and notice they are saying high-certainty evidence. Hedging language may be appropriate for a journal article reporting a single study, but itdoesn't make for clear English communication for the interested layperson, who I think will constitute the vast majority of our readers.

And the live attenuated vaccine has an even bigger proportional drop from placebo/no vaccine to vaccine. I'm comfortable saying "two-thirds or more reduction," or words to that effect. And after reading the relevant sections of this review article, I trust most of us will be comfortable making this or a similar statement. Cool Nerd (talk) 16:33, 8 February 2019 (UTC)


 * The source says "live influenza vaccines probably reduce influenza (moderate-certainty evidence) and may reduce ILI (low-certainty evidence) over a single influenza season. In this population inactivated vaccines also reduce influenza (high-certainty evidence) and may reduce ILI (low-certainty evidence). For both vaccine types, the absolute reduction in influenza and ILI varied considerably across the study populations" So the degree of reduction is variable Doc James  (talk · contribs · email) 05:48, 9 February 2019 (UTC)


 * I'm not sure why we'd expect a flu vaccine to help with other viruses. As the review article says, "Over 200 viruses cause ILI and produce the same symptoms (fever, headache, aches, pains, cough, and runny nose) as influenza."  This is in the "Plain language summary."  I'm not sure why they didn't put it in the main summary as well.


 * Now, when the article talks about live attenuated reducing the risk from "18% to 4%" and inactivated vaccine reducing the risk from "30% to 11%," I still think we can do better than around two-thirds or at least two-thirds. And do so without it bogging our article down too much.  I'll put on my thinking cap.  It may be a couple of days before I can get back to it. Cool Nerd (talk) 17:00, 9 February 2019 (UTC)

Influenza, commonly known as the flu or simply as flu
The introduction of the article mentions that Influenza is commonly known as the flu. While this the case in American English in particular, it is worth mentioning that in other varieties of English, particularly British English, it is commonly known as just  flu. It would be helpful to add this to the introduction. What do others think of this? --Dreddmoto (talk) 15:53, 3 December 2018 (UTC)


 * Good suggestion. I made a change. Cool Nerd (talk) 16:22, 8 February 2019 (UTC)

Appreciated. Thanks. It's not included now. --Dreddmoto (talk) 22:14, 19 February 2019 (UTC)

"Flu" and "the Flu"
One of these is sufficient in the first sentence. Doc James (talk · contribs · email) 05:40, 9 February 2019 (UTC)
 * Let's go with the simpler "Flu." Cool Nerd (talk) 16:41, 9 February 2019 (UTC)

The first sentence could mention that in different parts of the world it is known as "the Flu" or just flu. That would help to inform people. --Dreddmoto (talk) 17:03, 21 February 2019 (UTC)

Differential
We need to use secondary sources. Which source lists Lyme as part of the differential?

The first ref is a primary source.

The second ref does not mention flu. https://www.cdc.gov/lyme/signs_symptoms/rashes.html

Neither dose the third ref https://www.nice.org.uk/guidance/ng95/resources/lyme-disease-rash-images-pdf-4792273597

Doc James (talk · contribs · email) 10:32, 19 May 2019 (UTC)

I edited below. The first reference is now a secondary source on the differential diagnosis of summer flu. It cites the second reference, which goes into more detail about the topic.

Borreliacell (talk) 01:27, 22 May 2019 (UTC)

Differential diagnosis
In the summer, people who have flu-like symptoms not involving the respiratory system and also have an expanding rash larger than 5 cm should have the rash evaluated by a doctor for possible Lyme disease, especially if they have recently done outdoor activities where Lyme is common. The Lyme rash usually is not painful, does not itch, and disappears even without treatment. However, if Lyme is not promptly treated with recommended antibiotics, the disease can within weeks spread to the heart, nervous system, or joints and cause serious complications.

History correction
Another version suggests that the word Influenza in Latin/Italian is actually derived from the Arabic name of the disease anflwnza (أنفلونزا) which in simple translation means - Goat's nose. The reason is that some of the symptoms indicate runny and red nose, which resembles a goat's snout. Through the history of Romans traveling through the middle east, they came across the name anflwnza and started using it in their language as influenza. — Preceding unsigned comment added by 71.163.94.127 (talk) 13:25, 11 July 2019 (UTC)

Maori cenotaph
I thought this Maori cenotaph at Te Koura Marae in memory of lives lost to an influenza epidemic but I'm.not sure.on placement and the picture quality isn't fantastic. FloridaArmy (talk) 23:32, 4 August 2019 (UTC)

Information in infobox
The infobox stats, which readers will actually read, seem to say that 1-in-5 or 1-in-7 people who catch the flu will die. That has probably scared more parents than anything else on Wikipedia. Yes, influenza is dangerous, but probably at a minimum a major qualifier should be added (i.e. "Of _____ million total, 3 to 5 million extremely serious cases a year"). Randy Kryn (talk) 20:59, 22 October 2019 (UTC)
 * I added in further actual language used in the referenced sentence, "severe". So the three-to-five million number appearing in the infobox has referenced severe cases. How about making the first words of the descriptor: "Common, with..."? (as in "Common, with 3–5 million severe cases per year") for further accuracy, although I haven't looked at the sources to see if they say that catching the flu is common. Randy Kryn (talk) 03:02, 23 October 2019 (UTC)

cfr likely incorrect
The Case Fatality Rate for the Spanish Infuenza, aka 2–3%, with a Ref to [212] is wrong. It *must* be 10 times more, as 500 millions cases divided by 20 millions is around 25%. One can also check the definition of CFR on the wiki page. So either Ref.[212] is wrong (did not check) or a typo has been made reporting what Ref.[212] claims. Cheers. — Preceding unsigned comment added by Eatdirt (talk • contribs) 20:19, 4 February 2020 (UTC)

Edit request
Please add the disambiguation page Influenza (disambiguation) to the hatnote.

Change

to

-- 67.70.33.184 (talk) 05:04, 6 February 2020 (UTC)

I did something similar. Outriggr (talk) 06:36, 6 February 2020 (UTC)

Semi-protected edit request on 14 February 2020
(340–1000 million) please change 1000 million to 1 billion Manistee15 (talk) 03:03, 14 February 2020 (UTC)
 * Yes check.svg Done by TonyBallioni. Thanks .  Adrian J. Hunter(talk•contribs) 07:56, 14 February 2020 (UTC)

Disease Burden of Influenza in the US and estimated sickness, medical visits, hospitalization and death averted by vaccination in the US - CDC
Disease Burden of Influenza - CDC https://www.cdc.gov/flu/about/disease/burden.htm

Estimated Influenza Illnesses, Medical Visits, Hospitalizations, and Deaths Averted by Vaccination in the United States - CDC https://www.cdc.gov/flu/about/disease/2015-16.htm

"Influenza spreads around the world in yearly outbreaks, resulting in about three to five million cases of severe illness and about 290,000 to 650,000 deaths." - Interpreted, this seems to say that Influenza has ~%10 fatality rate. — Preceding unsigned comment added by 69.124.116.101 (talk) 19:05, 1 March 2020 (UTC)

Case fatality this year - wrong order of magnitude?
The current table of "major modern influenza pandemics" gives the following numbers for this year's seasonal flu:


 * estimated infected: 800 million globally
 * estimated dead: 0.45-1.2 million globally
 * case fatality rate: <0.015%

1.2 million / 800 million = .0015, i.e. 0.15% not 0.015%. The US-specific estimates give similar values. So something here is off by an order of magnitude, and I assume it's the CFR (since it's also unusually low compared to other seasonal flus).

67.70.165.140 (talk) 22:49, 14 March 2020 (UTC)
 * Yes. The numbers at  support 0.15%, not 0.015%.  But I've removed the figure.  The problem with CFR when an outbreak is ongoing is that there are many people who are infected and will die, but have not died yet.  The "current" CFR includes these people as cases but not as fatalities.  So it underestimates the fatality rate.  If someone has a decent source that explains this and wants to add an appropriate note to the table, please go ahead, but just including the current CFR alongside historical CFRs is misleading. Adrian J. Hunter(talk•contribs) 23:09, 14 March 2020 (UTC)